hossein moameri

Nosocomial infections remain one of the most severe public health issues, infecting millions of patients worldwide each year.  The global prevalence of nosocomial infections varies between 3.0% and 20.7%, with an incidence rate ranging from 5% to 10%. In this short article, we have tried to present a different perspective on the future of nosocomial infections from the author's viewpoint. According to our assessment, due to megatrends such as global exposure, population aging, and augmenting drug resistance, nosocomial infections are expected to become more severe in the future. On the other hand, advancements in health technologies such as e-health, Artificial Intelligence, the Internet of Things, and less invasive interventions form a new generation of hospitals capable of preventing and controlling nosocomial infections. Presenting novel approaches to nosocomial infection management will transform medicine. Therefore, it seems that in the following years, nosocomial infections will follow a different trend.

The world is changing rapidly, mainly due to the impact of megatrends that have an impact on the entire human life, particularly in medical sciences. Medical research methodologies such as cohort studies provide very critical information, but it is not clear what would be its destination in the future. In this short article, we have tried to offer a somewhat different perspective on the future of cohort studies by analyzing the texts and their conclusions from the author's viewpoint. According to our assessment, cohorts will play a key role in medical research, but their methodology will significantly change in terms of designing, implementing, analysing, and applying the findings. The new generation of cohort study extracts most of their information from electronic health records, and it is not just restricted to a particular geographic area. With the changes in the levels of occupational exposure, risk factors, and the introduction of Omics, likely, occupational and birth cohorts as well as human diseases will likely undergo fundamental changes in the future. Big data will provide researchers with new opportunities, but information extraction and analysis require a team of specialists from several scientific fields. Furthermore, participants are likely to play a more active role in setting priorities and implementing research findings.

Abdominal surgery is considered a high-risk procedure for the development of surgical site infection (SSI). Few studies have evaluated the relative importance of surgical site infection risk factors in terms of consistency in abdominal surgery. Therefore, this comprehensive review article mapped and summarized the evidence aimed to determine the relative importance of the risk factors and incidence of SSIs in abdominal surgery.

A literature review was conducted using electronic databases and search engines such as Scopus, PubMed, and Web of Science up to March 16, 2023. There was no language restriction for the papers to be included in the study. The relative consistency of the risk factors was measured and evaluated using the methodology of the Joanna Briggs Institute. Original peer-reviewed cohort and case-control studies were included if all types of SSIs were included. Meta-analysis was performed to determine the pooled estimates of SSI incidences.

Of 14,237 identified records, 107 articles were included in the review. The pooled incidence of SSI was 10.6% (95% CI: 9.02–12.55%, χ2=12986.44, P<0.001). Operative time and higher wound class were both significant consistent risk factors for SSI incidence. Patients’ educational status, malnutrition, functional status, and history of neurological/psychiatric disorders were all candidates for consistent risk factors, with insufficient evidence. 

The findings of the present study indicated that SSI in abdominal surgery was a multifactorial phenomenon with a considerable risk and had different risk factors with various relative importance. Determining the relative importance of the risk factors for the prevention and control of SSI is strongly recommended. This manuscript has been released as a preprint at the research square: (https://doi.org/10.21203/rs.3.rs-3219597/v1).

 Insulin resistance can be a predictor of adverse fatty liver disease and health problems.

 The present study aimed to investigate the effect of insulin resistance on fatty liver disease.

 This study used the data of 2,160 individuals registered in a cross-sectional study who were randomly selected from among clients of a nutrition clinic in Tehran from April to December 2019. Insulin resistance and beta-cell activity were calculated by the homeostasis model assessment formula. The study outcome was defined as having fatty liver disease. The odds ratio (95% CI) was calculated using logistic regression models.

 The mean age was 35 (± 9) in healthy subjects and 49 (± 8) in fatty liver disease patients (age range: 16 to 42 years). Nearly 34.5% of the individuals had fatty liver disease. According to the adjusted results of the logistic regression model, the risk of NAFLD was 1.05 (P < 0.001) for one unit increase in fasting insulin and 1.01 (P < 0.001) for one unit increase in 2-h insulin, which indicated the statistically significant relationship of NAFLD with fasting insulin and 2-h insulin. Also, the risk of NAFLD was 1.01 P < 0.001) for one unit increase in FPG, which was statistically significant. Moreover, the adjusted risk of NAFLD was 1.00 (P < 0.001) for one unit increase in 2-h glucose, which was not statistically significant. Finally, the adjusted risk of NAFLD was 1.29 (P < 0.001) for one unit increase in HOMA-IR, which was statistically significant.

 The findings of the present study demonstrated that insulin resistance could increase the risk of fatty liver disease. Also, each one-unit increase in fasting blood sugar, fasting insulin, and 2-h insulin increased the risk of fatty liver disease. Therefore, the results of this study may be useful for health policymakers to design suitable preventive and therapeutic interventions for those with NAFLD to prevent and control this disease.

Cesarean section rates have increased significantly over the past decade. This increase has not been clinically justified. The objective of this study was to investigate the effect of medical factors on the type of delivery.

This prospective cohort study was done on 200 pregnant mothers. The main exposure in this study was the medical reasons for cesarean section and the main outcome of cesarean delivery. The relative risk index was calculated using the Cox regression model.

Of the 196 pregnant women remained in the study, 40.31% had Cesarean section. Compared to non-medical factors, the risk of Cesarean section was higher (Relative Risk = 4.64) in mothers with medical factors. Also, the risk of elective Cesarean section was higher in mothers with medical factors (Relative Risk = 2.34). On the other hand, the risk of Cesarean section and elective Cesarean section was and higher in mothers with previous abortion (Relative Risk = 2.11) and hard labor (Relative Risk = 3.25), respectively. However, there was a significant relationship between maternal mental disorder during pregnancy and Cesarean section delivery (Relative Risk = 1.49).

Based on these results, there is an association between medical factors and type of delivery. Therefore, maternal preventable or controllable medical problems during pregnancy requires more attention.

Due to the controversial effects of mental health disorders during pregnancy on infant health, the present study aimed to evaluate the effect of gestational depression, stress, and anxiety on the growth of offspring at six months of age in disadvantaged communities in South of Iran.

The sample comprised of 470 pregnant women (response rate=98%) who are participated in the Bandar Abbas Pregnancy Cohort study. Maternal mental health was measured by the DASS-21 questionnaire during pregnancy. Data on infant growth was collected based on infant`s growth chart at six months of age. The relative risk of suboptimal infant growth was calculated by Modified Poisson regression models at 5% significant level.

The prevalence of depression, anxiety, and stress was 19.0%, 26.1% and 6.5%, respectively. At six months of age, the mean (SD) of infant`s weight (gram), height (cm) and head circumference (cm) were 7287.30 (1019.85), 63.23 (5.62) and 41.39 (2.70), respectively. Compared to normal mothers, the risk of suboptimal weight at six months of age significantly increased by 71% in mothers who were classified as having depression (Adjusted RR: 1.71, 95% CI: 1.07, 2.09). The presence of anxiety significantly increased the risk of suboptimal height at six months of age by 43% (ARR: 1.43, 95% CI: 1.07, 1.92). There were no statistically significant effects of ‎either depression anxiety or stress on the suboptimal head circumference at six months of age.

Our results showed that mental health disorders of pregnant women might adversely influence the weight and height growth of offspring within the first six months of age. Screening protocols to early diagnose of mental health disorders during pregnancy, and to strict follow up of diagnosed cases postpartum are proposed.

inappropriate diet and the lack of necessary nutrition receiving during pregnancy, effects on maternal and neonatal health. This study carried out to investigate the effect of maternal supplements during pregnancy on growth indices at birth. This cohort study was carried out on part of Bandar Abbas Cohort study data. The main exposure in this study was the consumption of dietary supplements during pregnancy and the dependent variable was the growth indices of newborns. The adjusted relative risk index using a Modified Poisson Regression model was applied. All analysis were performed using the STATA software. 196 of participants remained in the study. The age range of mothers was from 16 to 42 years old and the mean of that was 27.28 (± 5.62). 81, 84 and 149 of mothers had taken an iron supplement, multivitamins, and vitamin D irregularly respectively. 12.76%, 8.68%,18.88% of the newborns, had abnormal weight, height, and head circumference at birth respectively. The relative risk of low birth weight and consumption of multivitamin 2.65 was achieved. Also, the relative risks between low birth height and iron and multivitamin supplements were 3.54 and 4.56 respectively. There was a relationship between irregular consumption of iron and multivitamins during pregnancy with weight and height at birth, but there was no relationship between the consumption of nutritional supplements during pregnancy and the head circumference. Mothers' nutritional supplementation during pregnancy requires more attention.

The effect of maternal mental health during pregnancy on Cesarean section through implications of pre- and postnatal birth have narrowly been investigated. The aim of the present study was to investigate the effect of maternal mental health during pregnancy on the type of delivery in the suburbs of Bandar Abbas. 

This study used data of 200 mothers registered in a prospective cohort study on pregnant women in the suburbs of Bandar Abbas, South of Iran, during 2016-18. The presence of depression, anxiety, or stress in expecting mothers were measured by DASS-21 questionnaire and the outcome defined as having Cesarean section (Cesarean section) was measured at postpartum. The relative risk (95% CI) was calculated using Cox regression models. All analyses were performed using STATA statistical package, with a significance level of 5%.

Information of 196 mothers were collected (98% response rate); the mean age of the participants was 27.28 (±5.62) years. The prevalence of depression, anxiety, and stress was 13.8% (27), 40.4% (40), and 7.6% (15), respectively. Nearly 40% of mothers went through Cesarean section. Compared to mothers with good mental health, the risk of Cesarean section was 96% higher in depressed mothers (RR=2, 95% CI: 1.43–2.74) (p=0.001), 81% higher in anxious mothers (RR=1.81, 95% CI: 1.29-2.53) (p=0.003), and 75% higher in stressed mothers (RR=1.75, 95% CI: 0.86-3.56) (p=0.121).

The findings of this study showed that poor mental health, especially anxiety and depression, during pregnancy could increase the risk of Cesarean section. Accordingly, screening protocols for mental health status and prenatal counseling sessions are suggested for pregnant mothers to increase their informed decision on types of delivery.